HIGH-INTENSITY INTERVAL TRAINING AND MODERATE-INTENSITY AEROBIC EXERCISE FOR GENERALIZED ANXIETY DISORDER: A NARRATIVE LITERATURE REVIEW

Patrycja Małyszek; Julita Papińska; Magdalena Lengier; Małgorzata Świderska; Franciszek Pastuszak; Szymon Zych; Szymon Świstak; Natalia Powęska; Jakub Buziak; Julia Pielacha

doi:10.31435/ijitss.3(51).2026.6240

Authors

Patrycja Małyszek Cardinal Stefan Wyszynski University in Warsaw, Warsaw, Mazovia, Poland https://orcid.org/0009-0006-7324-573X
Julita Papińska Cardinal Stefan Wyszynski University in Warsaw, Warsaw, Mazovia, Poland https://orcid.org/0009-0007-1758-1373
Magdalena Lengier Cardinal Stefan Wyszynski University in Warsaw, Warsaw, Mazovia, Poland https://orcid.org/0009-0007-3402-6005
Małgorzata Świderska Cardinal Stefan Wyszynski University in Warsaw, Warsaw, Mazovia, Poland https://orcid.org/0009-0005-8964-8261
Franciszek Pastuszak Cardinal Stefan Wyszynski University in Warsaw, Warsaw, Mazovia, Poland https://orcid.org/0009-0003-8064-5377
Szymon Zych Cardinal Stefan Wyszynski University in Warsaw, Warsaw, Mazovia, Poland https://orcid.org/0009-0009-7904-6047
Szymon Świstak Cardinal Stefan Wyszynski University in Warsaw, Warsaw, Mazovia, Poland https://orcid.org/0009-0007-4382-3663
Natalia Powęska Uniwersytet Medyczny w Łodzi, Lodz, Łodz Voivodeship, Poland https://orcid.org/0009-0005-8574-7721
Jakub Buziak Franciszek Raszeja Municipal Hospital in Poznań, Poland https://orcid.org/0009-0004-5833-975X
Julia Pielacha Cardinal Stefan Wyszynski University in Warsaw, Warsaw, Mazovia, Poland https://orcid.org/0009-0004-6822-2520

DOI:

https://doi.org/10.31435/ijitss.3(51).2026.6240

Keywords:

Generalised Anxiety Disorder; High-Intensity Interval Training; Moderate-Intensity Continuous Training; Aerobic Exercise; Exercise Intensity; Anxiety; Mental Health

Abstract

Background: Anxiety disorders, including Generalised Anxiety Disorder (GAD), represent a leading global health burden. First-line treatments - pharmacotherapy and cognitive behavioural therapy - carry notable limitations including side-effects, high cost, and limited accessibility. High-Intensity Interval Training (HIIT) and Moderate-Intensity Continuous Training (MICT) have emerged as potential adjunctive interventions.

Aim of the study: To synthesise and critically evaluate available evidence on the effects of HIIT and MICT on anxiety symptom severity in individuals with GAD.

Material and methods: A narrative review of PubMed, Google Scholar, and PsycINFO (2009–2025) was conducted. Eligible sources included RCTs, systematic reviews, meta-analyses, and mechanistic studies addressing exercise interventions and anxiety outcomes.

Results: Both HIIT and MICT produce significant reductions in anxiety, comorbid depression, and somatic symptoms across clinical and non-clinical samples, with higher exercise intensity generally associated with greater benefit. In clinically diagnosed GAD, HIIT yielded approximately twice the effect size of lower-intensity training. However, MICT outperformes HIIT in certain subgroups. Baseline anxiety severity emerges as a key moderator of response.

Conclusions: HIIT holds potential as a first-line complementary treatment for GAD. MICT remains a valuable alternative for specific subgroups. Adequately powered, long-term head-to-head RCTs directly comparing HIIT and MICT in clinically diagnosed GAD are needed.

References

Plag, J., Schmidt-Hellinger, P., Klippstein, T., Mumm, J. L. M., Wolfarth, B., Petzold, M. B., & Ströhle, A. (2020). Working out the worries: A randomized controlled trial of high-intensity interval training in generalized anxiety disorder. Journal of Anxiety Disorders, 76, Article 102311. https://doi.org/10.1016/j.janxdis.2020.102311

Borrega-Mouquinho, Y., Sánchez-Gómez, J., Fuentes-García, J. P., Collado-Mateo, D., & Villafaina, S. (2021). Effects of high-intensity interval training and moderate-intensity training on stress, depression, anxiety, and resilience in healthy adults during coronavirus disease 2019 confinement: A randomized controlled trial. Frontiers in Psychology, 12, Article 643069. https://doi.org/10.3389/fpsyg.2021.643069

Herring, M. P., Jacob, M. L., Suveg, C., Dishman, R. K., & O’Connor, P. J. (2012). Feasibility of exercise training for the short-term treatment of generalized anxiety disorder: A randomized controlled trial. Psychotherapy and Psychosomatics, 81(1), 21–28. https://doi.org/10.1159/000327898

LeBouthillier, D. M., & Asmundson, G. J. G. (2017). The efficacy of aerobic exercise and resistance training as transdiagnostic interventions for anxiety-related disorders and constructs: A randomized controlled trial. Journal of Anxiety Disorders, 52, 43–52. https://doi.org/10.1016/j.janxdis.2017.09.005

Mason, J. E., & Asmundson, G. J. G. (2018). A single bout of either sprint interval training or moderate-intensity continuous training reduces anxiety sensitivity: A randomized controlled trial. Mental Health and Physical Activity, 14, 103–112. https://doi.org/10.1016/j.mhpa.2018.02.006

Gordon, B. R., McDowell, C. P., Hallgren, M., Meyer, J. D., Lyons, M., & Herring, M. P. (2018). Association of efficacy of resistance exercise training with depressive symptoms: Meta-analysis and meta-regression analysis of randomized clinical trials. JAMA Psychiatry, 75(6), 566–576. https://doi.org/10.1001/jamapsychiatry.2018.0572

Gordon, B. R., McDowell, C. P., Lyons, M., & Herring, M. P. (2017). The effects of resistance exercise training on anxiety: A meta-analysis and meta-regression analysis of randomized controlled trials. Sports Medicine, 47(12), 2521–2532. https://doi.org/10.1007/s40279-017-0769-0

Lucibello, K. M., Paolucci, E. M., Graham, J. D., & Heisz, J. J. (2020). A randomized control trial investigating high-intensity interval training and mental health: A novel non-responder phenotype related to anxiety in young adults. Mental Health and Physical Activity, 19, Article 100327. https://doi.org/10.1016/j.mhpa.2020.100327

Philippot, A., Moulin, P., Charon, M. H., Balestra, C., Dubois, V., de Timary, P., & Luminet, O. (2022). Feasibility of online high-intensity interval training (HIIT) on psychological symptoms in students in lockdown during the COVID-19 pandemic: A randomized controlled trial. Frontiers in Psychiatry, 13, Article 904283. https://doi.org/10.3389/fpsyt.2022.904283

Asmundson, G. J. G., Fetzner, M. G., DeBoer, L. B., Powers, M. B., Otto, M. W., & Smits, J. A. J. (2013). Let’s get physical: A contemporary review of the anxiolytic effects of exercise for anxiety and its disorders. Depression and Anxiety, 30(4), 362–373. https://doi.org/10.1002/da.22043

Rethorst, C. D., Wipfli, B. M., & Landers, D. M. (2009). The antidepressive effects of exercise: A meta-analysis of randomized trials. Sports Medicine, 39(6), 491–511. https://doi.org/10.2165/00007256-200939060-00004

Wang, Y., Zhang, X., Zhang, Y., & Zhang, H. (2025). The impact of high-intensity interval training on anxiety: A scoping review. Frontiers in Psychiatry, 16, Article 1515266. https://doi.org/10.3389/fpsyt.2025.1515266

Ramos-Sanchez, C. P., Schuch, F. B., Seedat, S., Louw, Q. A., Stubbs, B., Rosenbaum, S., Firth, J., van Winkel, R., & Vancampfort, D. (2021). The anxiolytic effects of exercise for people with anxiety and related disorders: An update of the available meta-analytic evidence. Psychiatry Research, 302, Article 114046. https://doi.org/10.1016/j.psychres.2021.114046

Stubbs, B., Vancampfort, D., Rosenbaum, S., Firth, J., Cosco, T., Veronese, N., Salum, G. A., & Schuch, F. B. (2017). An examination of the anxiolytic effects of exercise for people with anxiety and stress-related disorders: A meta-analysis. Psychiatry Research, 249, 102–108. https://doi.org/10.1016/j.psychres.2016.12.020

Singh, B., Olds, T., Curtis, R., Dumuid, D., Virgara, R., Watson, A., Szeto, K., O’Connor, E., Ferguson, T., Eglitis, E., Miatke, A., Simpson, C. E., & Maher, C. (2023). Effectiveness of physical activity interventions for improving depression, anxiety and distress: An overview of systematic reviews. British Journal of Sports Medicine, 57(18), 1203–1209. https://doi.org/10.1136/bjsports-2022-106195

Aylett, E., Small, N., & Bower, P. (2018). Exercise in the treatment of clinical anxiety in general practice: A systematic review and meta-analysis. BMC Health Services Research, 18, Article 559. https://doi.org/10.1186/s12913-018-3313-5

Schuch, F. B., Stubbs, B., Meyer, J., Heissel, A., Zech, P., Vancampfort, D., Rosenbaum, S., Deenik, J., Firth, J., Ward, P. B., Carvalho, A. F., & Hiles, S. A. (2019). Physical activity protects from incident anxiety: A meta-analysis of prospective cohort studies. Depression and Anxiety, 36(9), 846–858. https://doi.org/10.1002/da.22915

Rebar, A. L., Stanton, R., Geard, D., Short, C., Duncan, M. J., & Vandelanotte, C. (2015). A meta-meta-analysis of the effect of physical activity on depression and anxiety in non-clinical adult populations. Health Psychology Review, 9(3), 366–378. https://doi.org/10.1080/17437199.2015.1022901

Gordon, B. R., McDowell, C. P., Lyons, M., & Herring, M. P. (2020). Resistance exercise training for anxiety and worry symptoms among young adults: A randomized controlled trial. Scientific Reports, 10, Article 17548. https://doi.org/10.1038/s41598-020-74608-6

Bartley, C. A., Hay, M., & Bloch, M. H. (2013). Meta-analysis: Aerobic exercise for the treatment of anxiety disorders. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 45, 34–39. https://doi.org/10.1016/j.pnpbp.2013.04.016

Cotman, C. W., Berchtold, N. C., & Christie, L. A. (2007). Exercise builds brain health: Key roles of growth factor cascades and inflammation. Trends in Neurosciences, 30(9), 464–472. https://doi.org/10.1016/j.tins.2007.06.011

Wegner, M., Helmich, I., Machado, S., Nardi, A. E., Arias-Carrion, O., & Budde, H. (2014). Effects of exercise on anxiety and depression disorders: Review of meta-analyses and neurobiological mechanisms. CNS & Neurological Disorders—Drug Targets, 13(6), 1002–1014. https://doi.org/10.2174/1871527313666140612102841

Gibala, M. J., Little, J. P., Macdonald, M. J., & Hawley, J. A. (2012). Physiological adaptations to low-volume, high-intensity interval training in health and disease. The Journal of Physiology, 590(5), 1077–1084. https://doi.org/10.1113/jphysiol.2011.224725

Hallgren, M., Kandola, A., Stubbs, B., Nguyen, T. T. D., Wallin, P., Andersson, G., & Forsell, Y. (2020). Associations of exercise frequency and cardiorespiratory fitness with symptoms of depression and anxiety: A cross-sectional study of 36,595 adults. Mental Health and Physical Activity, 19, Article 100351. https://doi.org/10.1016/j.mhpa.2020.100351